Abstract T MP79: Baseline disparities and Outcomes in Public vs Private US Health Care Institutions: The SPS3 Trial
BACKGROUND: For optimal secondary stroke prevention timely access to medical care is paramount. Disparities in stroke care related to race-ethnicity, socioeconomic status and health care access are present. It is unclear if these variables are modified within a clinical trial setting. Our aims were to compare baseline demographic, clinical and neuroradiological features and clinical outcomes (recurrent stroke, death and myocardial infarction (MI)) in US participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial from public vs private institutions.
METHODS: There were 1677 participants from US sites. We characterized sites as “public” or “private” based upon for-profit status and source of operational funding. Baseline demographic, clinical and neuroradiological features between groups were compared using Chi-square and unpaired t-tests, as appropriate. Cox proportional hazard models were used to compare risk of outcomes between groups in crude and adjusted models including age, sex, hypertension, diabetes, smoking, dyslipidemia, ischemic heart disease, body mass index and race-ethnicity as co-variates.
RESULTS: Of the 1677 US patients, 1009 (60%) were enrolled at public and 668 (40%) at private institutions. There were significant differences in public vs. private groups with respect to age (60 vs 64 y, p=0.001), race-ethnicity (59% non-white vs. 24%, p <0.0001), and educational status (15% with <9 y of education vs 4%, p<0.0001). Antiplatelet use at the time of the index event was higher in the private group (43% vs 35%, p=0.0005). Over a mean of 3.7y (SD 2.0) of follow-up, no significant differences between groups were found with regards to stroke recurrence (Adjusted HR 1.2, 95% CI 0.9-1.5), death 0.9 (0.6-1.3) or MI 1.1(0.62-1.8).
CONCLUSION: Despite baseline demographic disparities between groups from public and private sites, there were no significant differences in this trial setting with regards to outcomes. It is possible that strict control of risk factors, adherence to protocol and active interventions during the trial overcame disparities associated with differences in institutions, including differences related to medical care prior to study enrolment.
Author Disclosures: L.K. Wilson: None. T.S. Field: None. L.A. McClure: None. C.L. White: None. O.R. Benavente: None.
- © 2015 by American Heart Association, Inc.